[Orthograde intestinal lavage in the preoperative preparation for colon surgery].
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Biomedical subjects
Publications and source records attributed to W Stock.
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Rubber band ligation, first described by Blaisdell, is an effective way of treating internal haemorrhoids. Treatment is ambulatory, thus saving time and costs. Experiences with 72 patients show this method to be superior to injection therapy and haemorrhoidectomy because of the simplicity of technique, the short period of treatment and the minimal discomfort for the patients. In our opinion rubber band ligation is the treatment of choice in managing internal haemorrhoids.
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Different methods of preservation are examined in long-lasting extremity ischemia in dogs. After preservation of 10 h duration by hypothermia and perfusion the status of energy-rich phosphates and pH was equivalent to the status after 2 h of ischemia under control conditions.
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A postischemic edema in hind limbs of dogs occurred after a 5 hours tourniquet ischemia. The protein distribution of edematous liquid, serum and lymph has been investigated by immunoelectrophoretic analysis. Using different identification reactions it could be demonstrated, that edematous liquid only differs from serum because of additional appearance of fibrinogen, so corresponding qualitatively and in so far estimated quantitatively to serum plasma. In connection with the osmotic pressure factors and postischemic hyperemia, as they have been demonstrated up to now, the severe changes of permeability seem to be a main factor in pathogenesis of postischemic edemas.
The symptoms of the tourniquet syndrome (hypotonia, tachycardia, postischemic edema, hypercaliemia, metabolic acidosis, myoglobinuria, renal insufficiency) could be observed after embolectomy of saddle embolism in 37 patients. 19 patients died postoperatively; heart insufficiency was demonstrated by autopsy in 14 patients. The pathophysiology of heart failure in tourniquet syndrome was studied in dog experiments after unilateral and bilateral hind limb ischemia. The development of shock turned out to be more severe after bilateral ischemia--comparable to saddle embolism--than after unilateral ischemia. The course of heart failure after recirculation could be referred to hypercaliemia, hypermagnesiemia, metabolic acidosis and hemoconcentration. The prophylaxis of the tourniquet syndrome can be practised by knowing the pathogenesis.
The biologically active partial sequence Arg-Gly-Phe-Phe (position B 22-25 of the insulin B chain) in the form of the synthetic tetrapeptidamide, was compared in several bioassays with the following analogous synthetic peptides: homoarginyl-, ornithyl-, lysyl-, citrullyl-, alanyl- and NG-nitroarginyl-Gly-Phe-Phe-NH2. The syntheses of the lysyl- and alanyl-tetrapeptidamides are described. After intraperitoneal injection of the peptides in doses of 3-100 mumol per 100 g rat, together with [U-14C]glucose, the natural sequence Arg-Gly-Phe-Phe showed the highest insulin like activity (incorporation of labeled carbon into the diaphragm). The activity of the homoarginyl peptide was a little weaker. The ornithyl- and the lysyl-peptide, however, showed a remarkably diminished activity. The activity of the citrullyl-peptide was even lower and the alanyl-peptide was inactive. In vitro assays with rat diaphragm showed the same range of effects for the elevation of glucose uptake and glycogen content of the diaphragm. The activity decreased in the following order: Arg- greater than Har- greater than Orn- greater than Cit-Gly-Phe-Phe-NH2. Alanyl- and Nitroarginyl-Gly-Phe-Phe-NH2 were without effect. In isolated fat cells the glucose oxidation was enhanced significantly only by the arginyl-peptide. The results show that among the structures examined the guanidino group carried by the C5 chain of arginine is the most effective. The results are in accordance with our preceding work [1] using semisynthetic insulins obtained from natural A-chain and synthetic B-chain variants. In these products the replacement of Arg B 22 by ornithine or lysine also led to drastically diminished activity and after replacement of Arg B 22 by alanine the activity also disappeared.
The arginine homologues 2-amino-3-guanidinopropionic acid, 2-amino-4-guanidino-butyric acid and 2-amino-6-guanidinocaproic acid (= homoarginine) were synthesized and transformed into their methyl esters. The latter, together with arginine methyl esters. The latter, together with arginine methyl ester, arginine diethylamide and some guanidino compounds without the arginyl structure (agmatine, isopentyl-guanidine and n-butylbiguanide) were examined with regard to their behaviour on isolated fat cells, concerning the adrenalin-induced depression of the ATP level and the stimulation of glucose oxidation. The homoarginyl and arginyl derivatives counteracted the effect of adrenalin by re-elevating the ATP level, and thus they exerted an insulin-like activity. The esters were slightly active, whereas the arginine diethylamide and agmatine had a marked effect. The shorter homologues of arginine were totally inactive. However isopentyl-guanidine and butylbiguanide followed the effect of adrenalin: they additionally lowered the ATP level and therefore they acted in opposition to insulin. For comparative reasons the same compounds were tested with regard to their effects on glucose oxidation. The results were consistent with those quoted above: the homoarginyl and arginyl derivatives (agmatine included) forced the glucose oxidation similarly to insulin, the shorter homologues were inactive, isopentylguanidine and butylbiguanide decreased it.
Experiments were performed on 19 mongrel dogs. Changes of transplantation antigens by anesthesia and by brain ischemia were identified in cytotoxic tests. Brain ischemia was responsible for the significant alterations in 5 antigens, anesthesia alone induced significant changes in 3 antigens.
The tourniquet-shock in dogs was produced after recirculation of ischemically stressed bilateral hind limbs. 4 of 7 dogs died within 5 hours after release of the tourniquets. The cause of heart failure could be defined by hypercaliaemia, metabolic acidosis and hemoconcentration. The development of tourniquet-shock could be suppressed by hypothermic preservation of the ischemic extremities.
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